scholarly journals The predictive value of TIMP-2 and IGFBP7 for kidney failure and 30-day mortality after elective cardiac surgery

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kevin Esmeijer ◽  
Abraham Schoe ◽  
L. Renee Ruhaak ◽  
Ellen K. Hoogeveen ◽  
Darius Soonawala ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Serum Creatinine ◽  
Predictive Value ◽  
Kidney Injury ◽  
Baseline Serum ◽  
Elective Cardiac Surgery ◽  
Post Surgery ◽  
C Statistic ◽  
Duration Of Surgery ◽  
Statistic Model

AbstractAcute kidney injury (AKI) is an important risk factor for chronic kidney disease, renal replacement therapy (RRT), and mortality. However, predicting AKI with currently available markers remains problematic. We assessed the predictive value of urinary tissue inhibitor of metalloprotease-2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP7) regarding the need for RRT, and 30-day mortality, in elective cardiac surgery patients. In 344 elective cardiac surgery patients, we measured urinary TIMP-2 and IGFBP7 and serum creatinine at baseline and directly after surgery. Discrimination of both urinary biomarkers was assessed by the C-statistic. Model improvement for each biomarker when added to a basic model containing serum creatinine and duration of surgery was tested by the net-reclassification index (cf-NRI) and integrated discrimination index (IDI). At baseline, mean age was 66 years and 67% were men. Of all patients, 22 required RRT following surgery. IGFBP7 pre- and post-surgery and change in TIMP-2 during surgery predicted RRT with a C-statistic of about 0.80. However, a simple model including baseline serum creatinine and duration of surgery had a C-statistic of 0.92, which was improved to 0.93 upon addition of post-surgery TIMP-2 or IGFBP7, with statistically significant cf-NRIs but non-significant IDIs. Post-surgery TIMP-2 and IGFBP predicted 30-day mortality, with C-statistics of 0.74 and 0.80. In conclusion, in elective cardiac surgery patients, pre- and peri-operative clinical variables were highly discriminating about which patients required RRT after surgery. Nonetheless, in elective cardiac surgery patients, urinary TIMP-2 and IGFBP7 improved prediction of RRT and 30-day mortality post-surgery.

scholarly journals Acute Kidney Injury in Cardiac Surgery with Cardiopulmonary Bypass

2021 ◽  
Vol 18 (6) ◽  
pp. 38-47
Author(s):  
Yu. S. Polushin ◽  
D. V. Sokolov ◽  
N. S. Molchan ◽  
R. V. Аkmalova ◽  
O. V. Galkina
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
Renal Dysfunction ◽  
Kidney Injury ◽  
Tubular Damage ◽  
Free Hemoglobin ◽  
Duration Of Surgery

Changes in classification criteria and active introduction of biomarkers of acute kidney injury (KDIGO, 2012) are changing approaches to diagnosis and treatment of postoperative renal dysfunction including cardiac surgery patients operated with cardiopulmonary bypass (CPB). The objective: to compare the detection rate of AKI after surgery with CPB with the use of biomarkers and kidney disease improving global outcomes criteria, as well as to evaluate the cause and localization of structural changes of the nephron.Subjects and Methods. A monocenter observational study among elective cardiac surgery patients (n = 97) was conducted. Inclusion criteria: age over 18 years, duration of surgery (coronary bypass surgery, prosthetic heart valves) from 90 to 180 minutes, no signs of end stage kidney disease. AKI was diagnosed based on changes in serum creatinine and biomarkers (NGAL, IgG, albumin in urine). The studied parameters were recorded 15 minutes after the start and end of anesthesia, as well as 24 and 48 hours after surgery. Retrospectively, the group was divided into three subgroups: 1) patients without AKI after surgery; 2) patients in whom signs of AKI were detected after 24 hours but regressed by the 48th hour; 3) patients in whom AKI persisted during all 48 hours of follow-up.Results. 24 hours after surgery, AKI based on KDIGO criteria was recorded in 56.3% of patients. Using biomarkers, signs of tubular damage (NGAL) at the end of anesthesia were detected in 95.9% of patients; after 24 hours, they were registered in 73.2% of cases. In a subgroup where AKI persisted for more than 24 hours, glomeruli were damaged in addition to tubules which was manifested not only by selective but also by non-selective proteinuria. The duration of CPB, hemodilution (Hb < 90 g/l), the release of free hemoglobin in the blood (> 1.5 mg/l) at low (< 1 g/l) values of haptoglobin were significantly associated with AKI development.Conclusion. The KDIGO criteria do not allow detecting a subclinical form of renal dysfunction which may occur in about 40% of patients after surgery with CPB. AKI can be caused by damage to both the tubular part of the nephron and glomeruli in cases of prolonged CPB with the development of hemolysis, the release of free hemoglobin in the blood, and persisting anemia at the end of the surgery. The NGAL assessment makes it possible to detect subclinical kidney injury in the absence of elevated serum creatinine levels.

P0199 : Acute kidney injury in cirrhosis: Baseline serum creatinine predicts patient outcomes

2015 ◽  
Vol 62 ◽  
pp. S380 ◽  
Author(s):  
F. Wong ◽  
J.G. O’Leary ◽  
K.R. Reddy ◽  
G. Garcia-Tsao ◽  
M.B. Fallon ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Serum Creatinine ◽  
Patient Outcomes ◽  
Kidney Injury ◽  
Baseline Serum ◽  
Baseline Serum Creatinine

Perioperative management after elective cardiac surgery: the predictive value of procalcitonin for infective and noninfective complications

2021 ◽  
Author(s):  
Alice Laudisio ◽  
Antonio Nenna ◽  
Marta Musarò ◽  
Silvia Angeletti ◽  
Francesco Nappi ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Postoperative Complications ◽  
Predictive Value ◽  
Odds Ratio ◽  
Rate Ratio ◽  
Perioperative Management ◽  
Incidence Rate Ratio ◽  
Adverse Outcomes ◽  
Elective Cardiac Surgery ◽  
The Third

Objective: Procalcitonin (PCT) has been associated with adverse outcomes after cardiac surgery. Nevertheless, there is no consensus on thresholds and timing of PCT measurement to predict adverse outcomes. Materials & methods: A total of 960 patients undergoing elective cardiac surgery were retrospectively evaluated. PCT levels were measured from the first to the seventh postoperative day (POD). The onset of complications was recorded. Results: Complications occurred in 421 (44%) patients. PCT on the third POD was associated with the occurrence of any kind of complications (odds ratio: 1.06; p: 0.037), and noninfectious complications (odds ratio: 1.05; p: 0.035), after adjusting. PCT above the median value at the third POD (>0.33 μg/l) predicted postoperative complications (incidence rate ratio: 1.13; p = 0.035). Conclusion: PCT seems to predict postoperative complications in cardiac surgery. The determination at the third POD yields the greatest sensitivity and specificity.

FC 051PREDICTIVE VALUE OF PLASMA NGAL:HEPCIDIN-25 FOR MAJOR ADVERSE KIDNEY EVENTS AFTER CARDIAC SURGERY WITH CARDIOPULMONARY BYPASS: A PILOT STUDY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Saban Elitok ◽  
Anja Haase-Fielitz ◽  
Martin Ernst ◽  
Michael Haase
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Roc Curve ◽  
Predictive Value ◽  
Kidney Injury ◽  
Urinary Output ◽  
Icu Admission ◽  
Plasma Ngal ◽  
Net Reclassification Improvement ◽  
Major Adverse Kidney Events

Abstract Background and Aims Neutrophil gelatinase-associated lipocalin (NGAL) and hepcidin-25 appear to be involved in catalytic iron-related kidney injury after cardiac surgery with cardiopulmonary bypass. We aimed to explore the predictive value of plasma NGAL, plasma hepcidin-25, and the plasma NGAL:hepcidin-25 ratio for major adverse kidney events after cardiac surgery. Method We compared the predictive value of plasma NGAL, hepcidin-25, and NGAL:hepcidin-25 with those of serum creatinine (Cr), and urinary output and urinary protein for primary endpoint major adverse kidney events (MAKE; acute kidney injury [AKI] stages 2 and 3, persistent AKI &gt; 48 hrs, acute dialysis, and in-hospital mortality) and secondary-endpoint AKI in 100 cardiac surgery patients at intensive care unit (ICU) admission. We performed ROC curve, logistic regression, and reclassification analyses. Results At ICU admission, plasma NGAL, plasma NGAL:hepcidin-25, and Cr predicted MAKE (area under the ROC curve [AUC]: 0.77 [95% confidence interval (CI) 0.60–0.94], 0.79 [0.63–0.95], 0.74 [0.51–0.97]) and AKI (0.73 [0.53–0.93], 0.89 [0.81–0.98], 0.70 [0.48–0.93]). For AKI prediction, NGAL:hepcidin-25 had a higher discriminatory power than Cr (AUC difference 0.26 [95% CI 0.00–0.53]). Urinary output and protein, plasma lactate, C-reactive protein, creatine kinase myocardial band, and brain natriuretic peptide did not predict MAKE or AKI (AUC &lt; 0.70). Only plasma NGAL:hepcidin-25 correctly reclassified patients for MAKE or AKI (category-free net reclassification improvement: 0.82 [95% CI 0.12–1.52], 1.03 [0.29–1.77]). After adjustment to the Cleveland risk score, plasma NGAL:hepcidin-25 ≥ 0.9 independently predicted MAKE (adjusted odds ratio 16.34 [95% CI 1.77–150.49], P = 0.014), whereas Cr did not. Conclusion NGAL:hepcidin-25 is a promising plasma marker for predicting postoperative MAKE.

Comparison of Predictive Value of Preoperative and Immediate Postoperative Proteinuria With Cardiac Surgery-associated Acute Kidney Injury

2018 ◽  
Vol 27 ◽  
pp. S522-S523
Author(s):  
Shahrul Hashim ◽  
Yeong Sing Lee ◽  
Kenny Cheng ◽  
Ashvin Nair ◽  
Sivakumar Krishnasamy ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Predictive Value ◽  
Kidney Injury

scholarly journals FREQUENCY OF ACUTE KIDNEY INJURY AMONG PATIENTS UNDERGOING CORONARY ANGIOGRAPHY

2021 ◽  
Vol 70 (Suppl-4) ◽  
pp. S828-32
Author(s):  
Sajid Khan ◽  
Abdul Hameed Siddiqui ◽  
Ariz Samin ◽  
Syed Hassan Mustafa ◽  
Akhtar Gul ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Coronary Angiography ◽  
Serum Creatinine ◽  
Study Design ◽  
Kidney Injury ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Baseline Serum ◽  
Control And Prevention

Objective: To determine the frequency of acute kidney injury among patients undergoing coronary angiography. Study Design: Descriptive cross-sectional study. Place and Duration of Study: Department of Cardiology, Hayatabad Medical Complex, Peshawar, from Jan 2018 to Jul 2018. Methodology: This study was conducted in the in the Department of Cardiology, Hayatabad Medical Complex, Peshawar from 22nd Jan 2018 to 22nd Jul 2018. Through a descriptive cross-sectional study design, a total of 116 patients scheduled for coronary angiography were included in the study in a consecutive manner and baseline / follow up serum creatinine was recorded to detect acute kidney injury. Results: In this study 116 patients were included, 61.2% males and 38.8% females. Mean age of the patients was 55.6 years with a standard deviation of 6.6 years. Mean baseline serum creatinine level was 0.9 ± 0.11mg/dl which was 1.5 ± 0.11 48 hours after coronary angiography (p 0.000). AKI was recorded in 19.8% of patients. Conclusion: Acute kidney injury after coronary angiography is not uncommon in our population. More studies are recommended on its risk factors and complications to draw future directions for its control and prevention.

Mo1892 Acute Kidney Injury in Cirrhosis: Baseline Serum Creatinine Predicts Patient Outcomes

2015 ◽  
Vol 148 (4) ◽  
pp. S-1075
Author(s):  
Florence Wong ◽  
Jacqueline G. O'Leary ◽  
K. Rajender Reddy ◽  
Guadalupe Garcia-Tsao ◽  
Michael B. Fallon ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Serum Creatinine ◽  
Patient Outcomes ◽  
Kidney Injury ◽  
Baseline Serum ◽  
Baseline Serum Creatinine

scholarly journals Incidence and Predictors of Acute Kidney Injury Among Women With Severe Pre-eclampsia at Mbarara Regional Referral Hospital

2021 ◽  
Author(s):  
Mariam Hassan ◽  
Roland Mayanja ◽  
Wasswa G.M Ssalongo ◽  
Natumanya Robert ◽  
Lugobe Henry Mark ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Risk Factor ◽  
Serum Creatinine ◽  
Independent Risk Factor ◽  
Statistical Significance ◽  
Kidney Injury ◽  
Referral Hospital ◽  
Chronic Hypertension ◽  
Baseline Serum ◽  
Regional Referral Hospital

Abstract BackgroundThe presence of acute kidney injury (AKI) in pre-eclampsia complicates treatment including; increasing length of hospital stay and a need to access services like dialysis which are largely expensive in resource-limited settings. We aimed to determine incidence and predictors of acute kidney injury among women with severe pre-eclampsia at Mbarara Regional Referral Hospital in southwestern Uganda. MethodsWe carried out a hospital-based prospective cohort study from 16 November 2018 to 18 April 2019, among pregnant women with severe preeclampsia followed up in the hospital. We enrolled 70 mothers with severe pre-eclampsia and eclampsia; we excluded patients with a history of chronic renal disease, chronic hypertension, and gestational hypertension.Data on socio-demographics, laboratory parameters, health system, obstetric and medical factors were collected. Baseline serum creatinine, complete blood count, and CD4 T-cell count were all done at admission (0-hour). Second serum creatinine was done at 48-hours to determine the presence of AKI. AKI was defined as a rise in serum creatinine of 0.3mg/dl or more from the baseline. The proportion of women diagnosed with acute kidney injury among the total number of women with severe pre-eclampsia was reported as incidence proportion. Univariate and multivariate logistic regression was used to establish the association of acute kidney injury and severe pre-eclampsia.ResultsIncidence of acute kidney injury was high (41.4%) among women with severe pre-eclampsia. Antenatal care attendance was protective 0.36 (0.16, 0.80), p<0.013 at bivariate analysis but had no statistical significance at multivariate analysis. Eclampsia was an independent risk factor for acute kidney injury. (aRR 2.74 (1.06, 7.08), P<0. 037.ConclusionThe incidence of acute kidney injury in patients with preeclampsia is high. Eclampsia is an independent risk factor of acute kidney injury.

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